Engineers in the Classroom Request

Fields with a red asterisk (*) are required.

School Information

School Name  *
Street Address  *
City  *
State  *
Zip Code  *
Closest Aeronautics Location?  *
(Visits must be within a 60 mile radius of an Aero facility)
Volunteer background check required? Yes    No
    If so, please upload the form  *

Requester Information

Requester Name  *
Requester Telephone Number  *   (format: xxx-xxx-xxxx)
Requester Email Address  *
Confirm Requester Email Address  *
Who are you?  * Counselor    Parent    Principal    Teacher    Other
    If Other, please define  *

School POC Information

Check if Requester is POC
POC Name  *
POC Telephone Number  *   (format: xxx-xxx-xxxx)
POC Email Address  *
Confirm POC Email Address  *

Additional Information

Suggested Dates * Preferred:
  Click Here to select a date
Note: Click the field to clear it's value.

Alternate Choice:
  Click Here to select a date
Note: Click the field to clear it's value.

School Level  *
Grade(s)  *
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
What is the setting? Auditorium      Classroom      Other
Approximately how many students?  *
Please upload class schedule     See Example
Technology Capabilities
Yes      No
(PowerPoint, Project Presentation, etc.)
    If Yes, what?  *
Will there be youTube access? Yes      No
Will supplies be provided? Yes      No
(Paper, scissors and tape for hands on activities.)
What would you like for the students to
gain from an EITC visit?

500 Characters Remaining
Additional Comments
500 Characters Remaining